Healthcare Provider Details

I. General information

NPI: 1871963785
Provider Name (Legal Business Name): CRYSTAL MCGARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 E TABERNACLE ST SUITE 7
ST GEORGE UT
84770-3163
US

IV. Provider business mailing address

249 E TABERNACLE ST STE 100
ST GEORGE UT
84770-2951
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-5131
  • Fax: 801-255-5131
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: